sexual health – Minivan News

Health Protection Agency plan youth services to bridge gap in sexual health education

A sexual health education pilot aimed at young people will be launched in Hulhumalé before the end of this year, the Health Protection Agency (HPA) has told Minivan News.

“There is no comprehensive sexual education in the schools,” said the source. “We have to keep talking about these issues, about how to keep young people safe.”

The pilot will provide a comprehensive sexual health and general health service to all young people aged 10-24 years old.

According to the agency’s Reproductive Health Unit (RHU), the the project will attempt to bridge gaps in sexual and reproductive health services for young people.

A member of an established health service provider, who wished to remain anonymous, highlighted age-appropriate guidelines as key barriers to sexual health education.

The comments come after the body of a new-born baby was discovered in a house in Maafanu earlier this week. Local media reported that the 18-year-old mother, currently in police custody, committed infanticide after having hidden her pregnancy.

National Guidelines

The national guidelines issued by the Ministry of Health and Gender prohibit some elements of sexual health education – including condoms and safe sex – until students are 18-years-old.

“There is a standard which is maintained by the health sector. There are a lot of cultural and religious barriers in providing this information,” the source told Minivan News.

“Unless those issues are not tackled, the stigma in accessing [health education] will not happen.”

Reticence in the health sector is mirrored in the family sphere, argued the source, who stated that family members are reluctant to speak candidly with their children about sexual health.

“There are some views of parents that if you talk about sexual health, they might go and do it.”

With no accurate information from schools or parents, the student will often turn to peers or the internet for support on sexual health, noted the source, which results in the rapid spread of mis-information.

Religious barriers

Under the 2008 constitution the Maldives is a 100 percent Muslim country, with national guidelines surrounding sexual and reproductive health being strongly influenced by religion.

A report conducted by the Department of National Planning in 2013 concluded that religious beliefs had been the reason behind an increase in trends such as a preference for home schooling, refusal of vaccination and other medical services for women.

Expressing a similar view, the health sector source noted that religion had contributed to some of the barriers in delivering sexual and reproductive health education.

“That’s a huge barrier actually on sexual health education, because there’s certain beliefs on providing information, or on family planning, on safe abortion,” stated the source.

“They [religious scholars] have a lot of myths related to sexual reproductive health.”

The source suggestion that there is support for the assimilation of religion into sexual health education delivery, but that disagreements between religious scholars had meant that progress was slow.

Next steps

The RHU project is underpinned by the imminent release of their new guidelines, National Standards for Adolescent and Youth Friendly Health Services for Young People.

These guidelines outlines the key standards for health education for all young people aged 10 – 24 years, ensuring that they will “enter the productive age in the fullest possible wellbeing.”

Noting the closure of previous similar projects, such as the Youth Health Café, the RHU noted that there are a number of difficulties in launching a new healthcare service.

The RHU source also wished to remain anonymous, reflecting the strong emotions provoked by discussion of sex education.

“Convincing people to initiate something in health facility is not easy,” they stated.

“It will be difficult. At present it is very difficult, unless the person is coming seeking the services it is difficult.”

When asked if they felt that young people are getting the right information at the right age, RHU representatives responded with a firm “no”.

“Not all. They are not getting that information. As far as access, there is no access.”

Issues regarding a lack of support services for sexual and reproductive health in the Maldives have been well-documented in the past.

A report entitled ‘Maldives Operational Review for the ICPD Beyond 2014‘, carried out by the Department of National Planning (DNP), claimed that incidents of infanticide and unsafe abortions are symptoms of a lack of sexual education in young Maldivians.

The report identified, “clear indicators of the imperative need to provide access to information on sexual reproductive health and reproductive health services to the sexually active adolescents

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“Social stigma, religious and social culture” hinder women’s sexual health, says Hope for Women

Young women’s sexual health is being compromised by “social stigma, religious and social culture,” argues Fathmath Nazeefa, Advocacy Officer at local NGO Hope for Women.

According to Nazeefa, many young Maldivians refrain from accessing the limited sexual health services due to these societal pressures.

“It is apparent in many cases we are lacking information in the family-planning area, early sexual engagements, and in gender stereotyping, which actually makes women to go ahead with child bearing practices even though that is not in their best practice,” Nazeefa told Minivan News.

Her comments came after the body of a new-born baby was discovered in a house in Maafanu yesterday. After local media reported that an 18-year-old committed infanticide after having hidden her pregnancy, police have today confirmed the girl in question was arrested this afternoon.

After being taken into custody at around 2:20pm, the girl’s will be detained for up to fifteen days pending a court appearance.

Nazeefa expressed particular concern over a lack of sexual health education for young women which prevents them from making informed choices.

“To prevent this, we need to educate the young minds starting from adolescents on human anatomy, reproductive health, and build their capacity to protect themselves from being sexually exploited.”

A lack of sexual education, argues Nazeefa, is “depriving [women] of their sexual rights and human rights as well.”

“The ultimate objective has to be the empowerment of girls and women so that they make the right choices,” she concluded.

Rise in Infanticide – DNP reports

Yesterday’s news of the abandoned baby girl – discovered after the mother was forced to seek medical treatment by her family – has brought attention to the issues surrounding sexual health services available to young women.

Local media reported yesterday that the 18 year-old gave birth on her own in the family bathroom, with family members unaware of her pregnancy.

According to one family member, the girl didn’t admit to giving birth – even during a doctors appointment arranged by her family.

“However, doctors kept questioning her about her marital status,” a young female member of the family told local newspaper Haveeru.

According to Maldivian law, the repercussions for fornication out of wedlock is flogging for both the man and the woman involved.

The Maldives is a 100 percent Muslim country, and it’s justice system is based on a hybrid of common law and Islamic Sharia.

Some critics of the justice system have also highlighted the lack of accountability for men in cases of extra marital fornication.

“These women are tainted for life and forever looked down upon. There were a couple of men too, but the islanders did not react in the same way against the men. They seem to be more easily accepted back into society, their sins are generally forgiven or forgotten in time,” a former court official, who wished to remain anonymous, had previously told Minivan News.

Issues regarding a lack of support services for women with unwanted pregnancies in the Maldives have been well-documented in the past.

The report identified, “clear indicators of the imperative need to provide access to information on sexual reproductive health and reproductive health services to the sexually active adolescents and youth population.”

Infanticide also appears to be increasing, as demonstrated by media reports cited in the study, which included several new born babies and few premature babies abandoned in parks, buried in secluded places, or thrown into the sea.

“These are clear indications for the need of life skills programmes and reproductive health education,” the study suggested. “Access and utilisation of contraceptives to avoid unwanted pregnancies must also be advocated to minimise these issues.”

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UNFPA calls for review of judicial practices surrounding sexual behaviour in the Maldives

The UNFPA has this week released the State of the World Population Report, along with a report focusing on the local context, titled “Reproductive Health Knowledge and Behaviour of Young Unmarried Women in the Maldives”.

The report includes recommendations calling on the state to review existing practices related to the matter within the judicial process, law enforcement, education and health sectors.

Minister of Education Aishath Shiham inaugurated the event, highlighting the state’s plans to resume awareness programs for adolescents in schools in 2014.

“The UNFPA’s Life Skills Package is the program that was most systematically and effectively run in Maldivian schools to tackle the issue of adolescent pregnancies. Over a 1000 people have been trained to be able to conduct this program. I am announcing here today that with the start of the new administrative year in 2014, the UNFPA Life Skill Package will be reintroduced,” she stated.

The minister further noted the importance of including similar concepts in teacher training courses.

Youth sexual behaviour outside marriage

The report states that while the age of marriage has been increased to 18 in the year 2000 – following which the average age of first marriage has risen to 19 in recent years – sexual and reproductive health services and commodity supplies remain available solely to married couples.

It states that while the “underlying assumption is that sexual intimacy does not or should not occur before marriage”, and while this is in accordance with societal and religious views, there is “ample evidence that this is inconsistent with the social realities of youth sexual behaviour”.

The report provides a number of studies supporting their findings, including a youth perception study conducted, in which 90 percent agreed that it is more common for “couples to initiate sexual intercourse before marriage”.

It further notes the existence of young female sex workers, citing the Biological and Behavioural Survey of 2008 which noted a prevalence of “unprotected sex with multiple partners” within the 15 – 17 age group and above.

Another cited study indicated that unsafe practices of abortion are more common among unmarried youth than their married counterparts.

“Pregnancy outside marriage is in fact, a criminal offence…Nevertheless, it has to be acknowledged that sexual activity is a consistent social reality…” the report stated, before pointing out that the issue contributes to the “public health burden of the country”, and that it stems from “a complex mix of health, social and legal consequences, primarily connected to the occurrence of pregnancy outside marriage”.

As the clearest evidence of extra-marital pregnancies, the report cites IGMH’s Family Protection Unit’s data, showing the occurrence of such pregnancies to be the third most common issue among patients it has attended to since it opened in 2006. It states that out of 41 cases recorded in an year, some have resulted from rape and sexual abuse.

“The social and legal implications connected to out of wedlock pregnancy creates an intricate link between pregnancy outside marriage and abortion. Consequently, unsafe abortion is a key issue among young Maldivian women,” it said.

Sexual and reproductive health knowledge

The report highlights that due to societal and religious taboos, sexual and reproductive health (SRH) knowledge among youth – especially unmarried youth – is alarmingly low.

The report states that information related to SRH is taught in schools within the Biology and Islam syllabuses, though not at a meaningful or significant level.

Highlighting the disparity between the number of men and women prosecuted for fornication under Sharia law, the report stated that “paternity testing is not used as admissible evidence in court and the opportunity for men to deny guilt makes male accountability something of a farce”.

The report concluded with a variety of recommendations to the health, education, judicial sectors, as well as media outlets.

In addition to encouraging various forms of awareness raising, the UNFPA called on the law enforcement sector to revise sentencing practices in which gender discrimination occurs, to review the current punitive practice of dissolving marriages if a child is born within a gestation timeframe inconsistent with the duration of marriage, and to review the non-acceptance of paternity testing in cases of extra-marital pregnancies.

Read the full report here (english).

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Maldivian youth need access to sexual reproductive health education, services: Department of National Planning

Maldivian youth need sex education and access to reproductive health services, given high numbers of unsafe abortions, rising infanticide, as well as increasing risk factors that contribute to the spread of sexually transmitted infections and HIV/AIDS, a Department of National Planning study has found.

The study examined how much human development progress has been achieved in the Maldives in terms of population and development, reproductive health and rights, gender equity, equality and empowerment of women as well as education during the period 1994 – 2012.

The thematic Programme of Action (PoA) goals were established during the 1994 Cairo International Conference on Population and Development (ICPD) and adopted by 179 participating governments, including the Maldives. Thus, the “Maldives Operational Review for the ICPD Beyond 2014” study was conducted under the supervision of the Department of National Planning (DNP) in collaboration with the United Nations Population Fund (UNFPA).

Overall the study found that the Maldives has “accomplished remarkable progress” in achieving the ICPD PoA goals, with “impressive advancements in all development areas… and notable achievements in sexual and reproductive health.”

However young people and women continue to lack access to quality services, particularly in regard to sexual and reproductive health, which is putting their health at risk.

Youth comprise the largest population group in the Maldives and “[with] the number of young people entering their reproductive years on the rise, special attention to ensure that adolescents and youth are provided with sufficient knowledge about their anatomies, sexual and reproductive health, contraceptives and sexually transmitted diseases is needed,” stated the study.

“Access to contraceptives is limited to the married population despite overwhelming empirical evidence suggesting the need to provide contraceptive information and access to the youth population,” the study noted.

“Information must also be provided on the risks of getting pregnant in young age and of unsafe abortion,” the report continued.

“Simultaneously, it is also essential to establish more comprehensive and confidential reproductive health services which are more accessible and affordable,” the study found.

The report repeatedly noted that although information regarding reproductive health, HIV and sexually transmitted infections (STIs) are technically “available to everyone regardless of age, gender and marital status…access to reproductive health services are still limited to the married population.”

However, even the married population is not always ensured access to accessible, affordable and confidential reproductive health services, according to the study’s findings.

Contraceptive use among married couples is “relatively low”, with “Only 27 percent of married women using modern methods”.

“With regard to reproductive rights, men often control decisions regarding women’s reproductive health, often based on religious and cultural grounds,” the report noted.

“[Furthermore,] the sudden growth of religious fundamentalism and conservative thinking is an emerging challenge, particularly for women and young girls,” the study stated. “There have been increase towards certain trends such as preference for home schooling and refusing vaccination and other medical services for women based on religious beliefs.”

Sex, drugs, and reproductive rights

The report highlighted the “clear indicators of the imperative need to provide access to information on sexual reproductive health and reproductive health services to the sexually active adolescents and youth population.”

High numbers of unsafe abortions – mostly through injections and pills – were noted as “one of the main causes of preventable maternal deaths in the country.”

Infanticide also appears to be increasing, as demonstrated by media reports of “several new born babies and few premature babies found in parks and/or buried in secluded places and/ or thrown into the sea,” said the report.

The lack of reproductive health rights and services for women and girls have also lead to observed increases in non-communicable diseases such as breast cancer and cervical cancers, according to the study.

Meanwhile, male reproductive health issues are often ignored, while “family planning and use of contraception is largely considered a woman’s responsibility.” Therefore, the study recommended strengthening awareness information and access to male reproductive health services.

In order to create the awareness needed about reproductive rights and reproductive health, the report suggested using “Carefully targeted programmes using innovative and youth friendly tools such as social media and text messaging.”

An interrelated issue includes widespread drug use and substance abuse among Maldivian youth, with cases reported to the Maldives Police Services increasing from 195 cases in 2001 to 1,160 cases in 2010, noted the study.

“The high level of drug usage coupled with the increase in commercial sex workers imposes great risks for HIV/AIDS and other sexually transmitted infections and reproductive tract infections,” said the report.

The lack of sexual reproductive health access and awareness combined with risk factors including sharing needles to inject drugs, sexual activities among adolescents and youth, extramarital sex, and commercial sex workers, “could contribute to an increase in the incidence and prevalence of STIs and HIV/AIDS,” the study found.

“It is therefore crucial to educate the population on the risks of STI’s and HIV/AIDS through carefully designed behavioural change communication strategies,” the report recommended. “It is equally important to promote awareness on the availability of voluntary counseling and testing services and contraceptives such as condoms in Male’ and in regional level.”

The report recommended giving special consideration to “identify these high risks groups and provide them with the necessary information, treatment and services.”

Age appropriate sexual and reproductive health education needs to taught in schools to combat the increasing “sexual health illnesses” in the Maldives, according to the Centre for Community Health and Disease Control (CCHDC).

In 2012, CCHDC’s Public Health Programme Coordinator Nazeera Nazeeb revealed that studies have found high risk behaviors – including “unprotected sex, drug and alcohol abuse, homosexuality and prostitution” – are putting young people at high risk of sexually transmitted diseases and HIV.

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